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Cleveland Clinic Journal of Medicine Nov 2022Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals ("rocks") in the semicircular canals of the inner ear, is the most common cause of brief symptoms... (Review)
Review
Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals ("rocks") in the semicircular canals of the inner ear, is the most common cause of brief symptoms of vertigo secondary to head and body movements. Diagnosing and treating it are simple to do in the medical office. This article reviews the differential diagnosis for patients presenting with dizziness and vertigo, the pathophysiology of BPPV, how to diagnose it using maneuvers to elicit symptoms and nystagmus, how to interpret the nystagmus pattern to determine where the rocks are, and how to treat it using different maneuvers to reposition ("roll") the rocks back where they belong.
Topics: Humans; Benign Paroxysmal Positional Vertigo; Semicircular Canals; Dizziness; Nystagmus, Pathologic; Patient Positioning
PubMed: 36319052
DOI: 10.3949/ccjm.89a.21057 -
American Family Physician Jul 2019More than 30 million U.S. adults have hearing loss. This condition is underrecognized, and hearing aids and other hearing enhancement technologies are underused. Hearing... (Review)
Review
More than 30 million U.S. adults have hearing loss. This condition is underrecognized, and hearing aids and other hearing enhancement technologies are underused. Hearing loss is categorized as conductive, sensorineural, or mixed. Age-related sensorineural hearing loss (i.e., presbycusis) is the most common type in adults. Several approaches can be used to screen for hearing loss, but the benefits of screening are uncertain. Patients may present with self-recognized hearing loss, or family members may observe behaviors (e.g., difficulty understanding conversations, increasing television volume) that suggest hearing loss. Patients with suspected hearing loss should undergo in-office hearing tests such as the whispered voice test or audiometry. Patients should then undergo examination for cerumen impaction, exostoses, and other abnormalities of the external canal and tympanic membrane, in addition to a neurologic examination. Sudden sensorineural hearing loss (loss of 30 dB or more within 72 hours) requires prompt otolaryngology referral. Laboratory evaluation is not indicated unless systemic illness is suspected. Computed tomography or magnetic resonance imaging is indicated in patients with asymmetrical hearing loss or sudden sensorineural hearing loss, and when ossicular chain damage is suspected. Treating cerumen impaction with irrigation or curettage is potentially curative. Other aspects of treatment include auditory rehabilitation, education, and eliminating or reducing use of ototoxic medications. Patients with sensorineural hearing loss should be referred to an audiologist for consideration of hearing aids. Patients with conductive hearing loss or sensorineural loss that does not improve with hearing aids should be referred to an otolaryngologist. Cochlear implants can be helpful for those with refractory or severe hearing loss.
Topics: Adult; Diagnosis, Differential; Hearing Loss; Hearing Tests; Humans
PubMed: 31305044
DOI: No ID Found -
Journal of Clinical Neurology (Seoul,... Jan 2021This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss,... (Review)
Review
This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.
PubMed: 33480192
DOI: 10.3988/jcn.2021.17.1.1 -
American Family Physician May 2011Speech and language delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to...
Speech and language delay in children is associated with increased difficulty with reading, writing, attention, and socialization. Although physicians should be alert to parental concerns and to whether children are meeting expected developmental milestones, there currently is insufficient evidence to recommend for or against routine use of formal screening instruments in primary care to detect speech and language delay. In children not meeting the expected milestones for speech and language, a comprehensive developmental evaluation is essential, because atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems. Types of primary speech and language delay include developmental speech and language delay, expressive language disorder, and receptive language disorder. Secondary speech and language delays are attributable to another condition such as hearing loss, intellectual disability, autism spectrum disorder, physical speech problems, or selective mutism. When speech and language delay is suspected, the primary care physician should discuss this concern with the parents and recommend referral to a speech-language pathologist and an audiologist. There is good evidence that speech-language therapy is helpful, particularly for children with expressive language disorder.
Topics: Age Factors; Child, Preschool; Counseling; Evidence-Based Medicine; Humans; Infant; Language Development; Language Development Disorders; Mass Screening; Parents; Physician's Role; Physicians, Primary Care; Prevalence; Preventive Health Services; Prognosis; Speech Disorders; Speech Therapy; United States
PubMed: 21568252
DOI: No ID Found -
Facial Plastic Surgery Clinics of North... Nov 2016Microtia reconstruction is a challenging endeavor that has seen significant technique evolution. It is important to educate patients and their families to determine the... (Review)
Review
Microtia reconstruction is a challenging endeavor that has seen significant technique evolution. It is important to educate patients and their families to determine the best hearing rehabilitation and ear reconstructive options. Microtia is often associated with aural atresia, hearing loss, and craniofacial syndromes. Optimal care is provided by multiple disciplines, including a reconstructive surgeon, an otologic surgeon, an audiologist, and a craniofacial pediatrician. Microtia management includes observation, prosthetic ear, autologous cartilage reconstruction, or alloplastic implant placement. Hearing management options are observation, bone conduction sound processor, or atresiaplasty with and without hearing aids. Appropriate counseling should be done to manage expectations.
Topics: Cartilage; Congenital Microtia; Directive Counseling; Humans; Prostheses and Implants; Plastic Surgery Procedures; Ribs; Transplantation, Autologous
PubMed: 27712823
DOI: 10.1016/j.fsc.2016.06.011 -
International Journal of... 2016The Spring 2016 issue of the International Journal of Telerehabilitation (IJT) presents original and innovative work in three diverse sections: usability, intervention,...
The Spring 2016 issue of the International Journal of Telerehabilitation (IJT) presents original and innovative work in three diverse sections: usability, intervention, and pedagogy, followed by a book review on teleaudiology. The contributors to this issue are notably multi-disciplinary and include an audiologist, computer scientists, engineers, an epidemiologist, occupational therapists, a rehabilitation counselor, a physician (physical medicine and rehabilitation), and speechlanguage pathologists. The common thread linking the Journal's authors and their manuscripts, is excellence in telerehabilitation related innovation.
PubMed: 27563385
DOI: 10.5195/ijt.2016.6197